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Encouraging openness in health care: Policy and practice implications of a mixed-methods study in the English National Health Service.

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cam.depositDate2022-03-18
cam.issuedOnline2022-06-22
cam.orpheus.counter7
cam.orpheus.successMon Jul 04 07:23:33 BST 2022 - Embargo updated*
dc.contributor.authorMartin, Graham
dc.contributor.authorChew, Sarah
dc.contributor.authorMcCarthy, Imelda
dc.contributor.authorDawson, Jeremy
dc.contributor.authorDixon-Woods, Mary
dc.contributor.orcidMartin, Graham [0000-0003-1979-7577]
dc.contributor.orcidMcCarthy, Imelda [0000-0002-4715-9831]
dc.contributor.orcidDixon-Woods, Mary [0000-0002-5915-0041]
dc.date.accessioned2022-04-01T23:30:06Z
dc.date.available2022-04-01T23:30:06Z
dc.date.issued2022-06-22
dc.date.updated2022-03-18T08:47:42Z
dc.description.abstractOBJECTIVE: The National Health Service (NHS) in England has introduced a range of policy measures aimed at fostering greater openness, transparency and candour about quality and safety. We draw on the findings of an evaluation of the implementation of these policies in NHS organisations, with the aim of identifying key implications for policy and practice. METHODS: We undertook a mixed-methods policy evaluation, comprising four substudies: a longitudinal analysis of data from surveys of NHS staff and service users; interviews with senior stakeholders in NHS provider organisations and the wider system; a survey of board members of NHS provider organisations and organisational case studies across acute, community and mental health, and ambulance services. RESULTS: Our findings indicate a mixed picture of progress towards improving openness in NHS organisations, influenced by organisational history and memories of past efforts, and complicated by organisational heterogeneity. We identify four features that appear to be necessary conditions for sustained progress in improving openness: (1) authentic integration into organisational mission is crucial in making openness a day-to-day concern; (2) functional and effective administrative systems are vital; (3) these systems must be leavened by flexibility and sensitivity in implementation and (4) a spirit of continuous inquiry, learning and improvement is required to avoid the fallacy that advancing openness can be reduced to a time-limited project. We also identify four persistent challenges in consolidating and sustaining improvement: (1) a reliance on goodwill and discretionary effort; (2) caring for staff, patients and relatives who seek openness; (3) the limits of values-driven approaches on their own and (4) the continued marginality of patients, carers and families. CONCLUSIONS: Variation in policy implementation offers important lessons on how organisations can better deliver openness, transparency and candour. These lessons highlight practical actions for policymakers, managers and senior clinicians.
dc.description.sponsorshipNIHR
dc.identifier.doi10.17863/CAM.83122
dc.identifier.eissn1758-1060
dc.identifier.issn1355-8196
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/335686
dc.language.isoeng
dc.publisherSAGE Publications
dc.publisher.departmentDepartment of Public Health And Primary Care, This Institute
dc.rightsAll Rights Reserved
dc.rights.urihttp://www.rioxx.net/licenses/all-rights-reserved
dc.titleEncouraging openness in health care: Policy and practice implications of a mixed-methods study in the English National Health Service.
dc.typeArticle
dcterms.dateAccepted2022-03-16
prism.publicationNameJ Health Serv Res Policy
pubs.licence-display-nameApollo Repository Deposit Licence Agreement
pubs.licence-identifierapollo-deposit-licence-2-1
rioxxterms.typeJournal Article/Review
rioxxterms.versionAM
rioxxterms.versionofrecord10.1177/13558196221109053

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